The Life of a Specimen Received by Mayo Medical Laboratories. Disclosures. Relevant Financial Relationship(s): Nothing to Disclose

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1 Jeff Wills, Operations Manager MML Matt Hanley, Operations Manager MML November 29, 2017 Disclosures Relevant Financial Relationship(s): Nothing to Disclose Off Label Usage: Nothing to Disclose 1

2 Internal Operations Overview 7/24 Hour Operation Process over 12 million tests/year Operation resides 4.9 miles from downtown campus Primary work units within Internal Operations Loading Dock Operation Receiving/Stabilization/Inspection Accessing/Processing Infectious Handling Liquid Handling Quality Assurance Final Quality Inspection Beyond The Berry Box 2

3 Loading Dock Operation 7/24 Operation Ranked as top loading dock on Mayo Campus (62 docks) Couriers/Carriers met at door 90% of daily work is on site by 10:00 a.m. 65% of daily volume arrives via Federal Express Box Cutter Automation 3 boxes/6 styros per minute Redirection of 10 staff due to box cutter automation Approximately 800 boxes arrive on dock daily SRR Tracking Process Instructions/POD Information Re-Icing/Stabilization/Inspection Every styro inspected for proper stabilization Special instructions provide crucial information Radioactive monitoring of all work Triage Pathology/Infectious samples 3

4 Accessioning/Processing Staffed 7/ Staff Lab Assistants Leads (Triage/Floor) Heavily staffed 5:00 a.m. 4:00 p.m. (T-Sat) Hourly output 4,500 6,000 tests/hour Staff comprised of full-time/part-time Accessioning/Processing Straight 8 shifts FIFO Verified Non-Verified Process Goal to complete 85% of daily work by noon POD s = Success In-hand/Label 100% of all work Multifunctional Staff Assignments 4

5 Infectious Handling Area Education in place for Category A Samples with clients Packaging Instructions Education available Blue C sticker in place Separate processing room Specific Routing Containers (IATA DOT) Liquid Handling Pour Off Aliquot Goal Promise is to deliver Cadillac service Provide 30,000 Pour Off s /Month 41,000 Aliquot mother tubes/months Produces 105,000 daughter tubes/month Automation systems in place Sarstedt Sarstedt Re-capper De-Pluggo De-Capper Automation handles approximately 50% of volume Staffed by 17 staff growing to 25 soon Stool Processing relocating to SDSC/Liquid Handling 5

6 Quality Assurance/Education Support all of the Internal Operation Areas Manage Quality Events Manage Operational Issues Delayed shipments Missing samples Operational Unhappy Paths Manage SOP s Staffed by 12 FTE s Education handles all training opportunities Manage competencies Preps for Audits/Inspection Final Quality Inspection Trash is a priority No trash receptacles on floor Trash/waste designated carts All dry ice/normal trash inspected High value add as a business Every patient matters Process allowed us to reduce dry ice volumes Recycling increased Top Green Unit across Mayo Clinic Recycle cardboard, sytros, cool packs and dry ice 6

7 Specimen Distribution Provide specimen delivery services to performing laboratories Superior Drive Support Center (SDSC) Hilton Building Sort and delivery of 30,000-35,000 specimens per average weekday Specimen Distribution Overview 46 Staff 1 Supervisor 1 Assistant Supervisor 3 Leads 41 Lab Assistants Schedule dictated by lab operations Staffed during peak hours Monday-Sunday Distribution picks up accessioned specimens from Internal Operations Two paths of workflow: Automated and Manual 7

8 Automated Sort Yaskawa Motoman System CSS input modules, Conveyors, AS1200T Sorters Sorts thawed specimens in 12x75 mm, 13x75 mm, and 14x84 mm tubes 70-75% of specimens received automation-ready Specimens manually loaded into pucks Pucks contain RFID tag Tags read at multiple points Pucks are loaded in order of priority Automated Sort Project Summary: ecting-a-sort-automation-solution-for-lean-manufacturing/ CSS input modules Scan specimen barcodes, bind to RFID tag Identify appropriate sorter and routes accordingly Conveyor divided into two zones Zone 1 supports CSS and Sorter units 1-3 Zone 2 supports CSS and Sorter units 4-6 8

9 Automated Sort AS1200T Sorters Each sorter contains sort locations for multiple labs Decks mapped according to requirements of each location Pull times for racks defined by variety of criteria Computer display highlights the rack when it is time to pull Staff remove the rack for delivery and replace it with an empty rack Sorters make highly-granular deliveries more practical Pour-off racks are delivered to Liquid Handling, all others placed on carts for lab delivery Rack tags allow tracking in STS software Manual Sort Manual sort is used for specimens which cannot be sorted through automation Strict Refrigerate or Frozen Odd-size containers Tissue blocks, slides Rubberbanded/Bagged specimens Ambient, Refrigerated, and Frozen sort tables Sort locations displayed on bins Software displays are matched to sort locations STS used for tracking 9

10 Manual Sort Strict Temperature Strict Refrigerate or Frozen specimens require special care Strict Refrigerate specimen racks are shipped and delivered on cool packs Strict Frozen specimens are shipped and delivered in styrofoam containers with a bed of dry ice Future Developments Frozen Bulk Sorter Sorts 4, 5, 6, and 10 ml vials Sort rate of 2,500 specimens/hour Real-time tracking in STS as specimens are sorted Scheduled for implementation 1 st Quarter

11 Future Developments Improved Manual Sort system Yaskawa software with improved visual management All sort processes will now use the same software Integrated LED sort-to-light system to reduce potential for mis-sorts (currently at 0.02%) Improved reach-in refrigerator to improve ergonomics and visibility Integrated workflow removes total steps compared to the current process Scheduled for implementation 4 th Quarter 2018 Deliveries Distribution staff run four delivery routes Downtown Hilton Building SDSC East SDSC West SDSC South As staff deliver racks at each location they scan the rack tags into STS The laboratory hard-receives specimens in Soft LIS upon receipt 11

12 Downtown Deliveries Berry truck arrives at Hilton Building 6:15 AM Hourly deliveries Monday-Saturday day shift Reduced delivery schedule evenings and Sundays Special runs during peak times Staff delivery cart to labs on a set priority schedule, utilizing freight elevators After deliveries, Mayo specimens are picked up from Central Processing for transport to SDSC labs Mayo specimens go through sort at SDSC prior to delivery SDSC Delivery SDSC designed for more granular deliveries Specimens pre-sorted and delivered directly to testing workstation Saves the laboratory time Drop lanes/windows allow delivery without lab entry ~300 discrete delivery locations at SDSC for 6 laboratories 12

13 Mayo STAT Deliveries Managed by Distribution during regular hours, Internal Operations during off-hours Limited test menu can use this process Busulfan Drugs of Abuse Process initiated by a page to the designated staff member by phlebotomy Staff member contacts the performing lab Staff member drives a fleet vehicle to Central Processing, retrieves specimen, returns to SDSC Specimen is immediately delivered to the performing lab Post-Analytic Automated Sort Sorters 5 and 6 also have the ability to sort into 150- count post-analytical storage racks Post-analytic sorts generally begins late-morning as pre-analytic volumes begin to drop off Specimens collected from labs by Post-Analytic are front-loaded into input drawers on the sorters Sorters will sort pre- and post-analytic specimens simultaneously, prioritizing pre-analytic specimens for delivery 13

14 Post-Analytic SDSC labs utilize a central walk-in outside the labs Peak hour staffing 1 Supervisor, 7 Lab Assistants Hourly pick ups Stored Refrigerated or Frozen Sorters 5 and 6 sort specimens into 150-count storage racks Delivery and Post-Analytic Metrics Through the end of October 10,188,966 specimens sorted 7,692,669 through automation 2,496,297 manual 7,972,269 specimens delivered 4,605,109 to SDSC labs 3,367,160 to Hilton labs 874 STAT deliveries 379,117 Mayo specimens delivered to SDSC 4,901,444 SDSC Post-Analytic specimens stored 79,592 SDSC Post-Analytic specimens pulled for repeat testing, validation, or other purposes 14

15 Questions & Discussion 15

16 MAYOMEDICALLABORATORIES.COM/2018PHLEBOTOMY 16